13 ms·

No hospital, just an emergency ‘department’. They’re popping up all over

62 points by howard941 8y ago

mr_toad 8y ago
> Patients in states like Texas and Colorado have reported receiving bills for thousands of dollars from emergency departments If you’re paying more than several hundred dollars for non-admitted treatment you’re being swindled. Outside a few treatments such as dialysis and chemotherapy anything that expensive warrants admission.
- deleted 8y ago
  [deleted]
- afarrell 8y ago
  > swindled Do people generally have a choice what ER they go to? I’ve definitely seen people complain on the internet because they were passed out on the sidewalk and someone called an ambulance on them which stuck them with a large bill.
  - mathgeek 8y ago
    This always raises an interesting question about the concept of charging someone for a service that they did not have an opportunity to ask for or consent to until after the fact. On one hand, you have doctors wanting to save or improve someone's life. On the other hand, especially when death is the result despite attempts to safe the patient's life, the person/estate has now incurred a cost that was potentially undesired.
    - JshWright 8y ago
      We (EMS) operate under "implied consent" in those cases. If someone is incapable of consenting to treatment, we assume that they would want to treated (because that's a better failure mode than not treating someone who does want it).
    - afarrell 8y ago
      The issue here is that we as a society recognize different standards of consent. In the framework of Medical Consent, if someone is unconscious, then they are implicitly consenting to medical treatment[1][2]. I don't have any background in contract law besides occasionally reading /r/legaladvice, but it seems unlikely that that matches our common-law concept of consent to a contract. So where does that obligation to pay for the ambulance come from? It doesn't exist in the UK, but did it before 1948? Are there statutes in US states which create that obligation? [1] First aid training my MIT's Office of Emergency Management [2] First Aid training my St. Johns Ambulance in London.
  - Spooky23 8y ago
    Yes, you can ask to be taken wherever. I grew up in a rural area and it was a big deal, because the volunteers were EMTs only and meeting the county paramedic could cost $500, and sometimes they would ask for air transport, which was either free (provided by state police) or $5,000+, depending on the day. Insurance pays $0 if you are not admitted.
  - dragonwriter 8y ago
    > Do people generally have a choice what ER they go to? Yes, people often take themselves to an ER and have more than one within reasonable range. > I’ve definitely seen people complain on the internet because they were passed out on the sidewalk and someone called an ambulance on them which stuck them with a large bill The majority of ER visits are not people who had an ambulance summoned when they were unconscious, but, yes, in that case people generally don't have a choice about whether they go to an ER or which one.
- lazyasciiart 8y ago
  There's plenty of scans that cost more than that on their own. I got dramatically run over as a pedestrian and while I turned out fine (for heavily bruised values of fine), I was certainly happy for them to verify that with a CAT scan and some xrays of the more scraped up limbs instead of have them say that it was probably just shock and since I couldn't remember if I had hit my head we could assume it was ok.
  - ixacto 8y ago
    Heck I went to the er for chest pains and what felt like an irregular heartbeat when I was 24. Had and ekg and everything. Was still around $300 (after jnsurance) even tho I was fine and it turned out to just be anxiety and dehydration. There is no way I should be convinced by some fucking insurance company that something like this would be better seen in urgent care. What about the 0.1% of people where it actually is serious? What if that allergy to peanuts your kid has is actually life threatening? You want the most comprehensive care available at the time available ASAP.
sys_64738 8y ago
Are these ERs or Urgent Care depts?
- deleted 8y ago
  [deleted]
- adrianmonk 8y ago
  Where I live there are both. The word on the street (thankfully no firsthand experience) is to pay attention to the name if you go there for a sprained ankle. If it says "emergency" in the name, you're going to pay a LOT more.
  - chrisseaton 8y ago
    Why would you go to an emergency room for a sprained ankle anyway? Doesn't seem like an emergency.
    - gowld 8y ago
      Because you might not be an expert in technical medical lingo, so you go to the nearest place with doctors.
    - dragontamer 8y ago
      Actually, a lot of people go to "emergency rooms" for rudimentary care. I'd bet that most people don't know the difference between "Urgent Care" and "Emergency Rooms".
    - justinph 8y ago
      Do people get a lot of education on what constitutes an emergency vs what can be treated at an urgent care? I certainly don't remember getting taught much. In my experience, an Urgent Care feels more like a screening room to real medicine than a place where treatments can occur. If you think you're sick, you might just go to the ER because they have everything there.
      - 8y ago
jrochkind1 8y ago
I would guess the major motivation for this is that the ED is one of the most profitable parts of the hospital? The article kind of hints at it, but doesn't really go out and say that.
- JshWright 8y ago
  In my experience it is often a "loss leader". ERs have to treat everyone, including the large number of people who are never going to pay a cent. However, by getting people in the door, you then control (for all intents and purposes) where they go if they need to be admitted.
- Spooky23 8y ago
  ERs lose money for real hospitals. Standalone ERs are borderline insurance fraud and make lots of money.
- chapium 8y ago
  Just look at the financial reports for hospitals using the standalone ed's. They are very profitable.
- paulddraper 8y ago
  On the contrary, ER is expensive and a loss leader. That's one reason why increasingly popular ASCs (Ambulatory Surgery Centers) charge significantly less than full hospitals for the same procedure: they don't have the overhead of maintain emergency capabilities.
time-domain0 8y ago
I saw these fake emergency rooms all over Texas in strip-malls. They shouldn't be allowed because they don't have the staff or resources to provide adequate care and delay life-saving interventional medicine.
- pukeythrowaway 8y ago
  Yeah, I'm going to disagree. I visited one just today while traveling, and it was a (figurative) life saver. I deal with cyclic vomiting syndrome, and when an episode hits, about only thing that stops it is a promethazine injection. Last night's episode had me retching every 5 minutes, starting from around 8pm. I figured since the nearby urgent care centers were closed, I'd suck it up and puke til 8am. By around 3am I gave up and was looking into where the nearest ER was. It turned out to be an ED as described in the article. Within 10 minutes of arriving, I was already through triage, and talking to a doctor. Within 20 minutes, I'd been poked, and another 20 until I was out the door. To top it off, I was expecting the $200 co-pay that comes from a normal ER visit, but was instead met with only a $75 co-pay. I'm gonna say this is a huge win over the alternatives.
  - oliwarner 8y ago
    In the UK a private prescription for this costs £1. It's IM so anyone can administer. And FWIW, get yourself a pack of the suppository version of this. Sounds like it'll save you a lot of inconvenience and money.
- chapium 8y ago
  This is simply not true, at least for the ones I've been to. They typically contain beds, a lab, and their own OR suite. They actually have extra overhead since they are self contained and do not have other departments to lean on. They are located in areas far from their main hospital, essentially extending fast emergency service to those regions. If patients need additional services they are transferred to the main hospital.
  - howard941 8y ago
squozzer 8y ago
>But critics say that having too many emergency departments in one community reduces the quality of care because it shrinks the amount of practice that local trauma-trained physicians get when treating complicated injuries. A similar argument was made when Northside Hospital tried to open a trauma center earlier this year, but withdrew after two other area hospitals with trauma centers contested the expansion. A spin on the Roemer Effect it seems. Florida apparently has a Certificate of Need policy.
tylerl 8y ago
Stand-alone emergency departments are definitely a good thing. At least, the kind we have in Redmond is. The "main" hospital is about 5 miles away from the stand-alone ER, both run by the same company. They have the full compliment of equipment and physicians you'd expect, and can handle most serious scenarios there. And most importantly, there is never a significant wait, while the hospital is usually very busy. If you need to be admitted, they ambulance you to the main campus at no charge. There really is no downside. You get the part of the hospital that matters, in more places. The only problem seems to be that people don't realize that they're available, so the ER at the primary campus is still overcrowded.

62 points by howard941 8y ago

> Patients in states like Texas and Colorado have reported receiving bills for thousands of dollars from emergency departments If you’re paying more than several hundred dollars for non-admitted treatment you’re being swindled. Outside a few treatments such as dialysis and chemotherapy anything that expensive warrants admission.

deleted 8y ago
[deleted]
afarrell 8y ago
> swindled Do people generally have a choice what ER they go to? I’ve definitely seen people complain on the internet because they were passed out on the sidewalk and someone called an ambulance on them which stuck them with a large bill.
- mathgeek 8y ago
  This always raises an interesting question about the concept of charging someone for a service that they did not have an opportunity to ask for or consent to until after the fact. On one hand, you have doctors wanting to save or improve someone's life. On the other hand, especially when death is the result despite attempts to safe the patient's life, the person/estate has now incurred a cost that was potentially undesired.
  - JshWright 8y ago
    We (EMS) operate under "implied consent" in those cases. If someone is incapable of consenting to treatment, we assume that they would want to treated (because that's a better failure mode than not treating someone who does want it).
  - afarrell 8y ago
    The issue here is that we as a society recognize different standards of consent. In the framework of Medical Consent, if someone is unconscious, then they are implicitly consenting to medical treatment[1][2]. I don't have any background in contract law besides occasionally reading /r/legaladvice, but it seems unlikely that that matches our common-law concept of consent to a contract. So where does that obligation to pay for the ambulance come from? It doesn't exist in the UK, but did it before 1948? Are there statutes in US states which create that obligation? [1] First aid training my MIT's Office of Emergency Management [2] First Aid training my St. Johns Ambulance in London.
- Spooky23 8y ago
  Yes, you can ask to be taken wherever. I grew up in a rural area and it was a big deal, because the volunteers were EMTs only and meeting the county paramedic could cost $500, and sometimes they would ask for air transport, which was either free (provided by state police) or $5,000+, depending on the day. Insurance pays $0 if you are not admitted.
- dragonwriter 8y ago
  > Do people generally have a choice what ER they go to? Yes, people often take themselves to an ER and have more than one within reasonable range. > I’ve definitely seen people complain on the internet because they were passed out on the sidewalk and someone called an ambulance on them which stuck them with a large bill The majority of ER visits are not people who had an ambulance summoned when they were unconscious, but, yes, in that case people generally don't have a choice about whether they go to an ER or which one.
lazyasciiart 8y ago
There's plenty of scans that cost more than that on their own. I got dramatically run over as a pedestrian and while I turned out fine (for heavily bruised values of fine), I was certainly happy for them to verify that with a CAT scan and some xrays of the more scraped up limbs instead of have them say that it was probably just shock and since I couldn't remember if I had hit my head we could assume it was ok.
- ixacto 8y ago
  Heck I went to the er for chest pains and what felt like an irregular heartbeat when I was 24. Had and ekg and everything. Was still around $300 (after jnsurance) even tho I was fine and it turned out to just be anxiety and dehydration. There is no way I should be convinced by some fucking insurance company that something like this would be better seen in urgent care. What about the 0.1% of people where it actually is serious? What if that allergy to peanuts your kid has is actually life threatening? You want the most comprehensive care available at the time available ASAP.

sys_64738 8y ago

Are these ERs or Urgent Care depts?

deleted 8y ago
[deleted]
adrianmonk 8y ago
Where I live there are both. The word on the street (thankfully no firsthand experience) is to pay attention to the name if you go there for a sprained ankle. If it says "emergency" in the name, you're going to pay a LOT more.
- chrisseaton 8y ago
  Why would you go to an emergency room for a sprained ankle anyway? Doesn't seem like an emergency.
  - gowld 8y ago
    Because you might not be an expert in technical medical lingo, so you go to the nearest place with doctors.
  - dragontamer 8y ago
    Actually, a lot of people go to "emergency rooms" for rudimentary care. I'd bet that most people don't know the difference between "Urgent Care" and "Emergency Rooms".
  - justinph 8y ago
    Do people get a lot of education on what constitutes an emergency vs what can be treated at an urgent care? I certainly don't remember getting taught much. In my experience, an Urgent Care feels more like a screening room to real medicine than a place where treatments can occur. If you think you're sick, you might just go to the ER because they have everything there.
    - 8y ago

jrochkind1 8y ago

I would guess the major motivation for this is that the ED is one of the most profitable parts of the hospital? The article kind of hints at it, but doesn't really go out and say that.

JshWright 8y ago
In my experience it is often a "loss leader". ERs have to treat everyone, including the large number of people who are never going to pay a cent. However, by getting people in the door, you then control (for all intents and purposes) where they go if they need to be admitted.
Spooky23 8y ago
ERs lose money for real hospitals. Standalone ERs are borderline insurance fraud and make lots of money.
chapium 8y ago
Just look at the financial reports for hospitals using the standalone ed's. They are very profitable.
paulddraper 8y ago
On the contrary, ER is expensive and a loss leader. That's one reason why increasingly popular ASCs (Ambulatory Surgery Centers) charge significantly less than full hospitals for the same procedure: they don't have the overhead of maintain emergency capabilities.

time-domain0 8y ago

I saw these fake emergency rooms all over Texas in strip-malls. They shouldn't be allowed because they don't have the staff or resources to provide adequate care and delay life-saving interventional medicine.

pukeythrowaway 8y ago
Yeah, I'm going to disagree. I visited one just today while traveling, and it was a (figurative) life saver. I deal with cyclic vomiting syndrome, and when an episode hits, about only thing that stops it is a promethazine injection. Last night's episode had me retching every 5 minutes, starting from around 8pm. I figured since the nearby urgent care centers were closed, I'd suck it up and puke til 8am. By around 3am I gave up and was looking into where the nearest ER was. It turned out to be an ED as described in the article. Within 10 minutes of arriving, I was already through triage, and talking to a doctor. Within 20 minutes, I'd been poked, and another 20 until I was out the door. To top it off, I was expecting the $200 co-pay that comes from a normal ER visit, but was instead met with only a $75 co-pay. I'm gonna say this is a huge win over the alternatives.
- oliwarner 8y ago
  In the UK a private prescription for this costs £1. It's IM so anyone can administer. And FWIW, get yourself a pack of the suppository version of this. Sounds like it'll save you a lot of inconvenience and money.
chapium 8y ago
This is simply not true, at least for the ones I've been to. They typically contain beds, a lab, and their own OR suite. They actually have extra overhead since they are self contained and do not have other departments to lean on. They are located in areas far from their main hospital, essentially extending fast emergency service to those regions. If patients need additional services they are transferred to the main hospital.
- howard941 8y ago

squozzer 8y ago

>But critics say that having too many emergency departments in one community reduces the quality of care because it shrinks the amount of practice that local trauma-trained physicians get when treating complicated injuries. A similar argument was made when Northside Hospital tried to open a trauma center earlier this year, but withdrew after two other area hospitals with trauma centers contested the expansion. A spin on the Roemer Effect it seems. Florida apparently has a Certificate of Need policy.

tylerl 8y ago

Stand-alone emergency departments are definitely a good thing. At least, the kind we have in Redmond is. The "main" hospital is about 5 miles away from the stand-alone ER, both run by the same company. They have the full compliment of equipment and physicians you'd expect, and can handle most serious scenarios there. And most importantly, there is never a significant wait, while the hospital is usually very busy. If you need to be admitted, they ambulance you to the main campus at no charge. There really is no downside. You get the part of the hospital that matters, in more places. The only problem seems to be that people don't realize that they're available, so the ER at the primary campus is still overcrowded.